Comparative study of Iselin's technique for the treatment of Bennett's fracture with large and small fragments.

Objective: The thumb is very exposed to trauma due to its position and function. Fractures of the base of the first metacarpal bone are very frequent in hand traumatology. Most Bennett's fractures are treated surgically. However, the optimal surgical approach is controversial. The aim of this study is to compare the results of closed reduction and percutaneous pinning in the treatment of Bennett's fracture of the base of firsthand metacarpal in fractures with both small and large fragments. Methods: We studied retrospectively the data of 40 patients treated for a Bennett's fracture in the department of orthopaedic and traumatologic surgery between January 2016 and December 2018. The purpose of this study was to compare the functional (pain, grip strength, first web space opening and thumb opposition) and radiological (quality of reduction and arthritic changes) results of the Iselin's technique for the treatment of Bennett's fractures in two groups of patients with large and small bone fragments according to the size of articular surface detached with the antero-medial fragment (superior or inferior to 25%). Results: The average age of the patients was 34 (range = 19-66) years. Males were by far the most affected (90%). We noted 24 cases of large fragment fractures (60%) and 16 cases of small fragment fracture (40%). An excellent overall functional result was found in 68.8% of cases of small fragment fractures versus 50% of cases of large fragment fractures. Radiological results were roughly similar. Conclusion: All surgical techniques aim to restore the articular congruence to the best, maintain the opening of the first web space and obtain a stable and painless trapezo-metacarpal joint. The Iselin's technique is simple, inexpensive and easy to perform even by inexperienced surgeons. It yields satisfactory results in most cases of Bennett's fracture regardless of the size of the fragment.

[Case report of isolated Crohn's disease of the stomach presenting as plastica linitis]. / Maladie de Crohn gastrique isolee simulant une linite plastique. A propos d'un cas.

INTRODUCTION: Crohn's disease of the stomach is rare. There is nearly always concomitant disease in the small bowel or colon. Gastric involvement occurs rarely as an isolated entity. Upper endoscopy is sensitive for detecting subtle disease but more extended lesions can mimic neoplasms such us linitis. Exégèse: A 74-year old female was admitted to hospital with abdominal pain, vomiting and weight loss. Upper endoscopy and radiology aspects was suspicious of gastric linitis. Multiple endoscopic biopsies of the stomach showed one granuloma, chronic inflammation and Helicobacter Pylori. Because of the importance of obstructive syndrome, the patient underwent surgery. The resected stomach concluded to a Crohn's disease. CONCLUSION: Through this observation, we review clinical characteristics, diagnostic difficulties and treatment options of Crohn's disease of the stomach.

[Alpha heavy chain disease. A Tunisian case]. / Maladie des chaines lourdes alpha. A propos d'un cas tunisien.

Alpha heavy chain disease is a rare affection in the West and reported mainly in developing countries with the improvement of hygienic conditions, the disease become rare in Tunisia, the last case was reported in 1991. The aim of the study is to report a new Tunisian case and to describe clinical, endoscopical and histological characteristics of the disease. The patient in a 37 years old male, presented with chronic diarrhoea associated with malabsorption syndrome. The diagnosis of alpha heavy chain disease was confirmed by histological examination of the resected intestine after surgery for intestinal obstruction. The patient received chemotherapy. The follow up is of two months.

[Role of intestinal flora in inflammatory bowel disease and probiotics place in their management]. / Role de la flore intestinale dans les maladies inflammatoires chroniques de l'intestin et place des probiotiques dans leur prise en charge.

The pathogenic role of certain microorganism of intestinal flora has been demonstrated in experimental colitis in animals and strongly suspected in inflammatory bowel disease in human, especially in Crohn's disease and pouchitis. Probiotics are living non pathogenic microorganisms that, upon oral ingestion exert benefits on human health by modulating enteric flora or by stimulation of local immune system. The aim of this article is to remind the role of intestinal flora in inflammatory bowel disease, the mechanism of inflammation induced by this flora and to review through the literature, the different clinical studies performed with probiotics in human.

[Pouchitis treatment by probiotics]. / Traitement des pochites par les probiotiques.

OBJECTIVES: The aim of the study was to review the principal effects of probiotics on pouchitis and identify their mechanisms of action. METHODS: The study was based on a review of all relevant studies published in the literature on the effects of probiotics in pouchitis and their possible mechanisms of action. RESULTS: Pouchitis is the major long-term complication after ileal pouch anal anstomosis for ulcerative colitis. The cause is still unknown but is likely to be multifactorial. An imbalance in the usual fecal flora was recently suggested. Most patients with symptoms of pouchitis respond promptly to antibiotics. However, 5-10% of them develop rapidly relapsing symptoms that required protacted therapy. Porbiotics are living microorganisms that ingested in adequate amounts exert beneficial effects. Promising results have been obtained with probiotics mainly in maintenance of remission of chronic pouchitis and also as induction of remission. CONCLUSION: These results suggest that restoring the microbial imbalance may offer an effective therapeutic alternative to patients with pouchitis.

[The overlap syndrome of autoimmune hepatitis and primary biliary cirrhosis. Clinical and therapeutic analysis of 5 cases]. / Syndrome de chevauchement hépatite auto-immune-cirrhose biliaire primitive. Analyse clinique et thérapeutique de 5 observations.

Autoimmune hepatitis and primary biliary cirrhosis are two different liver diseases. The aim of this study is to relate the clinical, serologic and histologic features of patients presenting the overlap syndrome, and to evaluate their response to therapy. This is a retrospective study concerning patients presenting overlap syndrome diagnosed between january 1998 and December 2001. Five patients fulfilled the diagnosis criteria of overlap syndrome. The optimal type of treatment of the overlap syndrome was not known. Treatment with UDCA or immunosuppressor alone are not efficient. Combination of these drugs should be evaluated in further studies.

[Pathogenesis of autoimmune hepatitis]. / Pathogenie de l'hepatite auto-immune.

OBJECTIVES: The aim of the study was to review the pathogenic mechanisms of auto-immune hepatitis. METHODS: The study was based on a review of all relevant articles from literature on the mechanisms of auto-immunity in auto-immune hepatitis. RESULTS: The precise mechanisms through which liver damage occurs are not fully understood. Auto-immune hepatitis seems to be a consequence of auto-antigen exposure, genetic predisposition and defective immuregulatory mechanisms. Auto-antigen is presented by class II molecules of the major histocompatibility complex. Cytokines and non specific auto-immune promotors modulate immune reactivity. Cell-mediated and antibody-dependent forms of cytotoxicity are probably interactive pathogenic mechanisms. CONCLUSION: Disturbance in the tight balance between auto-aggression and self-tolerance, affected by several internal and external factors are likely in auto-immune hepatitis.

[Peptic pyloroduodenal strictures treated by endoscopic balloon dilation and eradication of helicobacter pylori. Results of a prospective study]. / Traitement de la stenose ulcereuse pyloro-bulbaire par dilatation endoscopique et eradication de Helicobacter pylori. Resultats d'une etude prospective de 16 cas.

Endoscopic dilatation of pyloro-duodenal peptic stenosis is a safe and efficient procedure that constitutes an alternative choice to surgical management. Our aims is to evaluate efficiency of endoscopic balloon dilatation associated with Helicobacter pylori eradication. During a period of 3 years (January 1999-December 2001). 16 patients were included in this study. Successful endoscopic dilatation was obtained in 15 of them (93, 75%). No severe complications (perforations) happened. All patients were infected by Helicobacter pylori. The mean follow-up was 13 months. Endoscopic balloon dilatation associated with Helicobacter pylori eradication is a safe and efficient treatment of pyloro-duodenal peptic stenosis.

[Selective cyclooxygenase-2 inhibitors and the digestive tract]. / Inhibiteurs selectifs de la cyclo-oxygenase-2 et tube digestif.

The use of non steroidal anti-inflammatory drugs (NSAIDs) is tempered by the development of side effects primarily in the gastro-intestinal tract. These effects result mainly from inhibition of the enzyme cyclo-oxygenase (COX)-1. Two NSAIDs (celecoxib and rofecoxib) COX-2 specific inhibitors had considerably lower ulcerogenic rates and lower serious gastro-intestinal side effects when compared with other NSAIDs used in rheumatoid arthritis and osteoarthritis. However, the exact place of COX-2 specific inhibitors remain to be determined as compared with the association of other NSAIDs and proton-pump inhibitors in the elderly. The efficacy of COX-2 specific inhibitors in digestive tumors is still unclear.

[Prevalence of Helicobacter pylori infection in duodenal ulcer. Data of a prospective study apropos of 78 NSAID-negative patients with duodenal ulcer]. / Prévalence de l'infection à Helicobacter pylori dans la maladie ulcéreuse duodénale. Résultats d'une étude prospective à propos de 78 ulcéreux duodénaux AINS negatifs.

The aim of our study was to evaluate, the prevalence of Helicobacter pylori infection in duodenal ulcer tunisian patients not using non steroidal anti inflammatory drugs. Seventy eight patients having a non complicated duodenal ulcer and not using non steroidal anti inflammatory drugs were enrolled in this prospective study carried out between February 2000 and January 2001. Six gastric biopsies were undertaken in all patients; five for an histologic analysis and one for urease test. A serum sample was taken for a Helicobacter pylori serology. Patients were considered infected if two tests were positive. Helicobacter pylori infection was present in 77 patients (98.7%). Helicobacter pylori infection is still high among patients with a non complicated duodenal ulcer and not using non steroidal anti inflammatory drugs suggesting an empirical Helicobacter pylori eradication therapy in this group of patients.

[Prevalence of Helicobacter pylori infection in normal or asymptomatic patients]. / Prevalence de l'infection a Helicobacter pylori chez les sujets normaux ou asymptomatiques.

The propose of this prospective study was to assess the prevalence of Helicobacter pylori infection in asymptomatic subjects in year 2000. Ninety eight patients not suffering from upper gastrointestinal symptoms were enrolled in this study. The mean age was 39 years. Helicobacter pylori was present in 81 patients (82.7%). Helicobacter pylori infection increase with age. It was maximal between 30 and 50 years. Helicobacter pylori prevalence is still high in Tunisia as well as in most developing countries. Improvement of hygiene conditions will decrease this prevalence.

[Association of celiac disease and Crohn's disease. A case report]. / Association maladie coeliaque et maladie de Crohn. A propos d'une observation.

Crohn's disease and celiac disease are two chronic digestive diseases. The pathological mechanisms that lead to them are not known. Their association is rare leading to diagnostic and etiopathogenic problems. The aim of this study is to report clinical, endoscopical and histopathological characteristics of this association and to discuss the etiopathogenic links between these two diseases. The association of celiac disease and Crohn's disease is possible although rare. Many etiopathological mechanisms were suggested to explain such an association. In the case of celiac disease, the association with Crohn's disease is suggested by the characteristics of the diarrhea, the anoperineal lesions and will be confirmed by ileocolonoscopy and biopsy. In contrary, the diagnosis of celiac disease associated with Crohn's disease is frequently suggested by the endoscopy of upper gastrointestinal tract systematically practiced and will be confirmed by biopsy and serological celiac disease tests.

[Gastric stump MALT lymphoma: a case report and review of the literature]. / Lymphome malt développé sur moignon gastrique: a propos d'une observation et revue de la littérature.

Gastric stump lymphoma is uncommon. We report a case of MALT lymphoma of the gastric stump occurring in a 65 year-old male. This patient had undergone subtotal gastrectomy for a gastric peptic ulcer at age 51. Histologic findings in the initial gastric specimen showed follicular gastritis with Helicobacter Pylori. This previous gastric surgery cured the ulceration but did not remove the Helicobacter Pylori infection that led to the development of gastric lymphoma.

[Abdomino-pelvic actinomycosis. Report of 2 cases]. / Actinomycose abdomino-pelvienne. A propos de deux cas.

Actinomycosis is a chronic, granulomatous, suppurative and fistulasing infection related to a gram-positive bacteria (actinomyces israeli). Cervico-facial actinomycosis is the most common localization. The prevalence of abdomino-pelvic actinomycosis is increasing mainly with the increase of the use of intrauterin device. Its clinical presentation is variable and may mimic cancer or tuberculosis. The diagnosis of abdomino-pelvic actinomycosis is hard and most of the cases are detected during surgical exploration. We report two cases of abdomino-pelvic actinomycosis; in the first case, the disease was extended to the caecum and the abdominal wall. The skin biopsies made the diagnosis of actinomycosis, avoiding surgery. In the second case, the diagnosis of actinomycosis is made post operatively because of high suspicion of pelvic cancer. Through these two observations, we review pathogenesis of the disease, its clinical aspects and its diagnostic and therapeutic means.

[Epidemiological, clinical and parasitological data concerning intestinal amebiasis in northern Tunisia]. / Données épidémiologiques, cliniques et parasitologiques concernant l'amibiase intestinale dans le nord de la Tunisie.

In order to evaluate the principal characteristics of the intestinal amoebiasis in the north of Tunisia, one retrospective study review all cases diagnosed in principal gastroenterologic sections of the hospitals of Tunis. Twenty height cases of intestinal amoebiasis, 10 of which have an inflammatory bowel disease associated were included. Watery stools containing blood and mucus were the most important symptoms (25 cases). The endoscopic exam showed for all the cases non specific lesions. The diagnosis was based on histologic exam in 21 cases, on the positivity of serologic tests in 3 cases and on the presence of E. histolytica/dispar cysts in stools in 6 cases. In two cases, the diagnosis was made by therapeutic test.

[Treatment and outcome of Crohn's disease without initial complications. Results of a retrospective, multicenter Tunisian study]. / Traitement et evolution de la maladie de crohn initialement non compliquee. Résultats d'une étude rétrospective et multicentrique Tunisienne.

The purpose of this study was to estimate and achieve the factors that have an influence on the evolution of the Chron's disease. This study was done in 124 patients reaching the diagnosis of Chron's disease between 1988 and 1997. The evolution of this disease was achieved in 87 patients. The Chron's disease was inactive among 31 patients (35-6%)--with discontinous evolution in 42 patients (48.3%) and active chronic in 14 patients (16-1%). The active chronic form of Chron's disease was twice more frequent among the smokers and the patients with age above 40 years--but this difference has no statistical significance. The indication of surgical treatment was realised in 21 patients and it takes place as result of failure of medical treatment in 16 patients (76-2%)--an abcess in 2 patents (9-5%) and iatrogenic perforation in 1 patient (4-8%). The age-sexe-smoke--the intensity of the initial attack and the nature of the treatment had no influence in the need of the surgical interfference. The Chron's disease showed the less severe evolution in this study--the age above 40 years and the consumption of smoke increased the frequency of active chronic form.

[Primary biliary cirrhosis and autoimmune hepatitis overlap syndrome: therapeutic features in 5 patients]. / Syndrome de chevauchement hépatite auto-immune--cirrhose biliaire primitive. Analyse thérapeutique de 5 observations.

UNLABELLED: Autoimmune hepatitis (AIH) and primary biliary cirrhosis (PBC) are two different liver diseases, however diagnosis criteria of these two affections can be found in a same patient. The aim of this study is to relate the clinical, serologic and histologic features of patients presenting the overlap syndrome, AIH-PBC, defined by the presence of at least of two main criteria of each disease and to evaluate their response to therapy. PATIENTS AND METHODS: This was a retrospective study concerning patients presenting overlap syndrome diagnosed between January 1998 and December 2001. These patients had been treated with ursodesoxycholic acid (AUDC) or prednisone and azathioprine or a combination of these three products. Clinical and biological criteria were used to assess response to therapy. RESULTS: Five patients fulfilled the diagnostic criteria of overlap syndrome. All patients were females, the median age was 38 years (range: 19-65 years). Three patients were treated by UDCA, a clinical and biological response was noted in only one patient. Two patients were treated by prednisone and azathioprine without any remission. Three patients were treated by a combination of these three products with a good response in two cases. CONCLUSION: Optimal treatment for overlap AIH-PBC syndrome remains to be determined. Treatment with UDCA or immunosuppressor alone is not efficient. A combination of these drugs should be evaluated in further studies.